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Form 13656 - Notice Of Election By Executive And Related Person To Participate In Announcement 2005-19 Settlement Initiative Page 4

Information and Documentation Required to Process Election by

Section IV. —

continued

Executive and Related Person

10.

Provide a computation of any change in the tax liability of the Related Person as a result of this Election.

11.

Is the Executive or Related Person currently in tax litigation

12.

Provide copies of all federal tax returns filed by the Related

with the government?

Person and the Executive from the date the options or

restricted stock was transferred to the Related Person to the

Yes

(Provide a copy of the complaint

present.

or the Tax Court petition.)

13.

Provide a schedule listing the names, addresses, and SSNs

14.

Has the Executive filed a Qualified Amended Return

(as defined

of the following:

pertaining to the transaction?

by Treas. Reg. §1.6664-2(c)(3))

All partners or members of the Related Person and

Yes

The spouses of partners or other members of pass-

(Provide a copy.)

through entities who filed joint returns for any taxable

period affected by the terms of the settlement.

15.

Has the Executive filed a disclosure statement pertaining

16.

Has the Executive or the Related Person received a Form W-2

to the transaction pursuant to Announcement 2002-2?

or Form 1099 pertaining to the transaction?

Yes

(Provide a copy.)

(Provide a copy of all forms.)

Instructions

Send your completed Form 13656 to:

Internal Revenue Service

ATTN: Announcement 2005-19

MC 4166 NWSAT

4050 Alpha Road

Farmers Branch, TX 75244

If you are under examination or in Appeals, please

provide a copy of this Notice of Election to the

examining revenue agent or the Appeals Officer.

13656

Sheet 4 of 4

Department of the Treasury – Internal Revenue Service

Form

(3-2005)

Catalog No. 39565K

Form 13656 - Notice Of Election By Executive And Related Person To Participate In Announcement 2005-19 Settlement Initiative Page 4

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